By James Gossage, Bijan Modarai, Arun Sahai, Richard Worth

The purpose of the a hundred instances sequence is to supply a singular studying and revision instrument that works by means of guiding scholars via medical instances, imitating those who scholars and condo officials are inclined to meet in twist of fate and emergency and outpatient departments, and in most cases practice.The instances are written to curiosity scholars in scientific difficulties and to assist them advance their talents of medical reasoning, with every one situation delivering info of a patient's scientific background and the main findings of a scientific exam, including preliminary research effects info for evaluation.Key questions then advised scholars to judge the sufferer, and succeed in a choice concerning the patient's situation and the prospective remedy plan; whereas the reply pages may help scholars to appreciate the procedures clinician or health professional is going via in such occasions. Designed with the scholar in brain, this quantity comprises gains to help self-directed studying, scientific considering and problem-solving.100 instances in surgical procedure covers universal and more odd proceedings offered, within the following surgical strong point parts: vascular, breast, endocrine, urology, orthopedic, neurosurgery, higher GI, reduce GI, anesthesia, and submit operative problems.

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Approximately 70 per cent of adult intussusceptions are caused by tumours • colonic pseudo-obstruction: pseudo-obstruction or Ogilvie syndrome is seen most often in the elderly patient with chronic or severe illness. In approximately 20 per cent of patients, the ileocaecal valve is competent resulting in a ‘closed-loop’ obstruction which does not allow decompression into the small bowel. The large bowel gradually dilates with maximal dilatation occurring in the caecum. Gross dilation (Ͼ10 cm) with tenderness over the caecum is a sign of impending perforation and requires prompt surgery.

How can the tumour be staged upon histological examination of the resected specimen? • Which groups of patients are at risk of developing colorectal cancer? 37 100 Cases in Surgery ANSWER 18 The study shown is a barium enema in a patient with a tumour at the splenic flexure (arrow). The appearance is typical of the narrowing of the colon lumen caused by an ‘applecore lesion’. A colonoscopy would help to delineate the pathology within the colon and would allow biopsy to provide a tissue diagnosis.

5°C, the pulse rate is 69/min and the blood pressure is 150/85 mmHg. The abdomen is soft and non-tender with no masses or organomegaly. Digital rectal examination is unremarkable and rigid sigmoidoscopy to 20 cm does not show any abnormality. Urgent investigation is requested and shown below. 5 ng/mL A barium enema is performed (Fig. 1). 1 Barium enema. Questions • What does the barium enema in Fig. 1 show? • What investigation is required for adequate preoperative staging? • How can the tumour be staged upon histological examination of the resected specimen?

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